SRI AUROBINDO COLLEGE OF DENTISTRY, INDORE 1

DEPARTMENT OF ORTHODONTICS & DENTOFACIAL

ORTHOPEDICS

JOURNAL CLUB PRESENTATION - 02

“MCNAMARA ANALYSIS”

PRESENTATION BY –MADHU MEENA

PG 1st year
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INTRODUCTION

 A method of cephalometric analysis that is sensitive not only to the

position of the teeth within a given bone but also to the relationship
of the jaw elements and cranial base structures one to another.
 In short, the method of analysis described here represents an effort
to relate teeth to teeth, teeth to jaws, each jaw to the other, and the
jaws to the cranial base.
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The composite normative standards used in the McNamara analysis were

derived from three sources :
1)Lateral cephalograms of the children comprising the Bolton
standards.
2) Selected values from a group of untreated children from the Burlington
Research Centre.
3) A sample of 111 young adults from Ann Arbor, having good to
excellent facial and dental configurations and good skeletal balance with
an orthognathic facial profile.
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CRANIOFACIAL SKELETAL COMPLEX

 1) Maxilla to cranial base.

 2) Maxilla to mandible.
 3) Mandible to cranial base.
 4) Dentition.
 5) Airway.
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MAXILLA TO CRANIAL BASE

 1) Soft tissue evaluation

a) Nasolabial angle
b) Cant of upper lip
 2) Hard tissue evaluation
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NASOLABIAL ANGLE: Drawing a line tangent to the base of the
nose and a line tangent to the upper lip.

Acute nasolabial angle may be

reflection of the dentoalveolar
protrusion.

Normal value : 102° ± 8º

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CANT OF THE UPPER LIP:

 It should be slightly forward to

form an angle of about:
in women: 14° ± 8°
in men : 8° ± 8°
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HARD TISSUE EVALUATION :

 The linear distance is measured

between nasion perpendicular and
point A
 It determines the antero-posterior
orientation of the maxilla relative to
the cranial base

 In well balanced faces:

mixed dentition = 0
adult = 1mm
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An example of maxillary skeletal protrusion of 5mm and retrusion of
-4mm

Protrusion of 5mm Retrusion of -4mm

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MAXILLA TO MANDIBLE

 Anteroposterior relationship
Effective midfacial length :
Measured from condylion to point A

Effective mandibular length :

Measured from condylion to gnathion
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 The effective length of the midface and the mandible are not age or sex
dependent but are related only to the size of the component parts.

Thus the term ‘small’ , ‘medium’ , ‘large’ are used

Maxillomandibular difference = midfacial length – mandibular length

In small individuals the difference should be between 20 and 23 mm
In medium sized persons the difference should be between 27 and 30mm
In large individuals the difference should be 30 and 33mm
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 If the discrepancy is greater or smaller than the normative values.

 Then next step is to identify which jaw is small or large or both

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VERTICAL RELATIONSHIP

• Vertical maxillary excess can cause a downward and backward rotation of the
mandible increasing lower face height.
• Vertical maxillary dentoalveolar deficiency will cause the mandible to rotate
upward and forward reducing the lower anterior face height .
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 Lower face height in the mixed dentition with a midface length of

85mm should be 60-62mm
 Lower face height in medium – sized individuals with a midface
length of 94mm should be 65-67mm
 Lower face height in large individuals with midface length of
100mm should be 70-73mm
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MANDIBULAR PLANE ANGLE

 It is the angle between Frankfort and the line drawn along the lower
border of the mandible through constructed gonion and menton.
Mandibular plane angle is 22º ±4º
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 Higher mandibular plane angle is suggestive of excessive lower

face height

 Lesser mandibular plane angle would tend to indicate a deficiency

in lower face height
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FACIAL AXIS ANGLE :

 Angle between a line from basion to

nasion and the facial axis (PTM to
Gn)
 In a balanced face , the facial axis
angle is 90°
< 90° ( -ve value ) indicates excessive
vertical development
> 90° (+ve value ) indicates deficient
vertical development
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MANDIBLE TO CRANIAL BASE

 The relationship of the mandible to the cranial

base is determined by measuring the distance
from pogonion to nasion perpendicular
 In mixed dentition : 6-8 mm posterior to nasion
perpendicular , but moves forward during growth
 In adult women : 4-0mm behind nasion
perpendicular
 In adult men : 2mm behind to approximately
2mm forward of nasion perpendicular .
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DENTITION :

 In planning orthodontic treatment (orthodontic , orthopedic , or

surgical purpose) one must determine the anteroposterior position
of both upper and lower incisors.
 We need to know the relationship dentition in the both the jaw to
the underlying basal bone.
 The dentition can be neutral . Protrusive or retrusive
 -MAXILLARY INCISOR POSITION
 -MANDIBULAR INCISOR POSITION
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MAXILLARY INCISOR POSITION

 To measure the position of the

maxillary incisors in relation to its
apical base.
 A vertical line is drawn through point
A parallel to nasion perpendicular.
 The distance from point A to facial
surface of incisor is measured.
 It should be 4-6 mm.
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Example of severely protruding upper incisor
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MANDIBULAR INCISOR POSITION

 The distance is measured between the

edge of the mandibular incisor and a
line drawn from point A to pogonion
(A-pog line )
 In well balanced face, the distance
should be 1-3 mm.
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ASSESSMENT OF VERTICAL
POSITION OF LOWER INCISOR.

 If the curve of spee is excessive , a decision must be made whether

the lower incisor should be intruded or molars erupted.
 The determining factor is the lower anterior facial height.
 If the lower facial height is normal or excessive the lower incisor
should be intruded.
 If the lower anterior facial height is deficient then the lower incisor
should be extruded or the buccal segments further erupted.
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AIRWAY ANALYSIS

 Upper pharynx
Width is measured from a point on
the posterior outline of the soft
palate to the closest point on the
pharyngeal wall.
Average : 15-20mm in width
A width of 22mm or less in this
region may indicate airway
impairment.
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 Lower pharynx:
Its width is measured from the
point of intersection of the
posterior border of the tongue and
the inferior border of the mandible
to the closest point on the posterior
pharyngeal wall.
Average : 11-14mm.
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 suggests anterior positioning of the tongue, either as a result of

habitual posture or due to an enlargement of the tonsils.
 Determination of tongue position is important in the diagnosis of
certain clinical conditions, such as mandibular prognathism,
dentoalveolar anterior crossbite, or bialveolar protrusion of the
teeth.
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REFERENCES

1 ) Broadbent BH: A new x-ray technique and its application to

orthodontia. Angle Orthod I: 45-66, 1931; reprinted in Angle
Orthod 51: 93-l 14, 1981.
2 )Downs WB: Variation in facial relationships: their significance
in treatment and prognosis. AM J ORTHOD 34: 812-840, 1948.
3) Downs WB: The role of cephalometrics in orthodontic case
analysis and diagnosis. AM J ORTHOD 38: 162-182, 1952.
4) Downs WB: Analysis of the dento-facial profile. Angle Orthod
26: 191-212, 1956.
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5) Steiner CC: Cephalometrics for you and me. AM J ORTHOD 39:

729-755, 1953.
6) Steiner CC: Cephalometrics in clinical practice. Angle Orthod 29: 8-
29, 1959.
7) Steiner CC: T P e use of cephalometrics as an aid to planning and
assessing ort odontic treatment. AM J ORTHOD 46: 721-735, 1960.
8)Tweed CH: Evolutionary trends in orthodontics, past, present, and
future. AM J ORTHOD 39: 81, 1953.
9)Tweed CH: The Frankfort-mandibular incisor angle (FMIA) in
orthodontic diagnosis, treatment planning and prognosis. Angle Orthod
24: 121-169, 1954.
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Thank you